The Krampus and the Old, Dark Christmas-Full-thickness Contact Alkali Burn With Soot, Milking Grease and Baby Oil.

A chemical alkali burn caused by ash and soot is quite rare, resulting from its high pH-value, and underestimated in its potential to cause injury. In folkloric medicine, ash was purportedly used to relieve pain. We present an unusual case of a 27-year-old man who used a self-mixed cream of soot of wooden pellets, milking grease and baby oil to blacken his face and hands for a traditional Krampus procession.

Edema facial y bilateral de piernas en un paciente tratado con quetiapina / Facial and bilateral leg edema in a patient using quetiapine

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Nose burns: 4-dimensional analysis.

The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.

Orbital compartment syndrome in a burn patient without aggressive fluid resuscitation.

INTRODUCTION: Orbital compartment syndrome may rarely occur in the setting of burns where therapy includes aggressive fluid resuscitation. CASE: We report a case of bilateral orbital compartment syndrome in a 13-year-old male, with superficial facial burns secondary to hydrobromic acid, who did not receive aggressive fluid resuscitation. The patient was treated successfully with bilateral lateral canthotomy and cantholysis. COMMENT: Facial burns may lead to orbital compartment syndrome without aggressive fluid resuscitation, likely due to excessive leakage of fluid and protein into the orbit combined with an inflammatory reaction.

Burns due to acid assaults in Bogotá, Colombia.

Acid burns are not very frequent, occupying between 3% and maximum 14% of all etiologies. They mostly occur at home or at work, however there has been an increase in publications outlining chemical burns where aggression is the cause of this burn. There is a different epidemiological profile between developed countries and developing ones. It seems an ongoing upsurge is occurring in the number of registered attacks within developing countries in recent years. A cross sectional retrospective review of attacks by acid was done in Bogota, Colombia from 1995 to the first trimester 2012. A cumulative number of 35 burn patients were registered during the study period. It is found that the main target, almost the unique target, of this attack are young women belonging to low socioeconomic status with low education degree and high dependence on her partner. The patient's age mean was 22.7 years, ranging from 13 to 41 years. The physical and psychological scars were very severe.

Secondary reconstruction of burned nasal alae using rolled dermal flap with overlying full-thickness skin graft.

INTRODUCTION: Surgical reconstruction of the nasal tip is a very delicate procedure, as it must rebuild three different anatomical planes: mucosa, cartilage and skin with functional and aesthetic requirements. This procedure is even more difficult in burns patients, due to more limited donor sites and poor skin quality. Numerous flap options are available to reconstruct defects of the tip of the nose. The authors report their experience of nasal alar reconstruction by a scar tissue remodelling technique using a rolled dermal flap with overlying full-thickness skin graft. PATIENTS AND METHODS: The medical charts of seven patients (five women and two men with a mean age of 30) treated between 1991 and 2006 were retrospectively reviewed. Six patients presented sequelae of a facial burn and one patient had congenital facial hemiagenesis. RESULTS: Reconstruction was bilateral for all burns patients and unilateral for the patient with facial hemiagenesis. The skin graft was raised from the medial aspect of the forearm in four cases, the retroauricular region in two cases and the groin in one case. One patient required a second surgical procedure for necrosis of the nasal tip. No nasal obstruction was reported with a mean follow-up of five years (range: six months to 15 years). CONCLUSION: The rolled dermal flap with overlying full-thickness skin graft is a simple and reliable procedure for reconstruction of the nasal alae. Filling of the nasal alae defect and reconstruction of all anatomical planes are achieved in a single surgical procedure. The aesthetic and functional results were satisfactory, with minimal scarring of the donor site. This technique is very suitable for the treatment of burn sequelae and can also be used to treat nasal hemiagenesis and nasal mutilation by biting or facial trauma.

A case report of a chemical burn due to the misuse of glacial acetic acid.

As young and elastic skin is what everyone dreams of, various measures have been implemented including chemical, laser resurfacing and dermabrasion to improve the condition of ageing skin. However, the high cost of these procedures prevents the poor from having access to treatment. Glacial acetic acid is widely used as a substitute for chemical peeling because it is readily easily available and affordable. However, its use can result in a number of serious complications. A 28-year-old female patient was admitted to our hospital with deep second-degree chemical burns on her face caused by the application of a mixture of glacial acetic acid and flour for chemical peeling. During a 6-month follow-up, hypertrophic scarring developed on the both nasolabial folds despite scar management. Glacial acetic acid is a concentrated form of the organic acid, which gives vinegar its sour taste and pungent smell, and it is also an important reagent during the production of organic compounds. Unfortunately, misleading information regarding the use of glacial acetic acid for chemical peeling is causing serious chemical burns. Furthermore, there is high possibility of a poor prognosis, which includes inflammation, hypertrophic scar formation and pigmentation associated with its misuse. Therefore, we report a case of facial chemical burning, due to the misuse of glacial acetic acid, and hope that this report leads to a better understanding regarding the use of this reagent.

Explosive nasofacial cryptococosis.

Cryptococcal skin infection in persons with AIDS has been demonstrated. We describe a patient with nasal and facial infection with cryptococci after traumatic injury with battery acid.

Ocular and systemic morbidity profile in mass formic acid injuries.

BACKGROUND AND OBJECTIVE: A report on formic acid-induced ocular and systemic injuries. PATIENTS AND METHODS: Forty-two passengers (84 eyes) with formic acid burns following a tanker and bus collision were evaluated and treated. The severity of ocular chemical injury was assessed using the Roper-Hall classification. Standard protocol for management of ocular chemical burns was adopted in all patients. Immediate irrigation of the eyes was done with tap water and all patients received frequent topical steroids, cycloplegics, and lubricating eye drops. Systemic injuries were evaluated and managed collectively by plastic and orthopedic surgeons and internists. RESULTS: On presentation, 48 (57.14%) eyes had grade 0, 13 (15.48%) eyes had grade I, 16 (19.1%) eyes had grade II, 3 (3.57%) eyes had grade III, and 4 (4.76%) eyes had grade IV chemical injuries. Thirty patients (71.43%) had superficial and 12 (28.57%) had deep skin burns. One (2.38%) patient died due to severe pulmonary edema and 6 (14.29%) patients had severe pulmonary complications requiring oxygen treatment. Seventy-two (87.8%) eyes healed without residual sequelae, 10 (12.2%) eyes had nebulo-macular corneal opacities, and 2 (2.44 %) eyes developed secondary glaucoma and dry eye. CONCLUSION: Formic acid injuries can lead to a significant ocular and systemic morbidity. Immediate ocular and systemic management is necessary to reduce morbidity and mortality. Strict regulations are needed for the transportation of dangerous chemicals to prevent accidental chemical injuries.

[Injury following sodium hypochlorite irrigation during endodontic treatment]. / Letsel na irrigatie met natriumhypochloriet tijdens een endodontische behandeling.

A 58-year-old woman was referred by her dentist to a maxillofacial surgeon because of a rapidly increasing facial swelling. The swelling developed after sodium hypochlorite irrigation during the endodontic treatment of tooth 25. A mechanical heart valve, a heart rhythm disorder, and antithrombotic therapy were complicating medical conditions. Treatment consisted of 12 mg dexamethason administered once intravenously, augmentin administered thrice daily intravenously, and oral analgetics. Damage following sodium hypochlorite irrigation during endodontic treatment is a rare disorder which is associated with a severe reaction in the surrounding tissue. Damage can be permanent.

Negotiating state and NGO politics in Bangladesh: women mobilize against acid violence.

This note showcases the story of Nurun Nahar, a survivor of acid violence in Bangladesh, to demonstrate that, despite protective measures, state, medical, and legal institutions continually fail to adequately respond to violence against women systematically and deny women rights to state protection, which are affirmatively embodied in law. The failure of state institutions to ensure appropriate care has been somewhat mitigated by nongovernmental organizations (NGOs), particularly women's groups, which are albeit heavily constrained because of the volume of demand yet scarcity of expertise, infrastructure, and funds. In addition, this note offers some thoughts on how nonstate actors, namely, women's NGOs, have created alternative strategies and visions for victimized women's recovery and empowerment.

Facial motion analysis of acid burn victims--development of a new facial motion impairment index.

OBJECTIVES: Evaluation of facial movement is necessary for the assessment of motor deficits and planning reconstructive surgery in facial burns. Clinicians recognise the need for an accurate and reproducible method of functional assessment. We propose a new facial functional impairment index (FFII) for assessing facial motor dysfunction due to severe burn injury and provide inter/intra-patient comparison for documenting rehabilitation. METHODS: The maximal static response assay (MSRA) was used to compare facial movement in 20 acid burn victims with 20 control subjects. Data compiled from 12 soft tissue landmarks was used to quantify rest and dynamic asymmetry, anatomic and non-anatomic motion and calculate the FMII. The Katz score, Nottingham index and number of affected aesthetic units provided insight into FFII efficacy. RESULTS: Patients with greater aesthetic disfigurement demonstrated significantly poorer anatomic function (c=0.62; p=0.03) as well as larger global facial functional impairment (c=0.52; p=0.08). CONCLUSION: Acid burns caused severe asymmetry and functional impairment. The FFII is a composite score of global function based on a reproducible method of data collection and it differentiated between acid burn victims and provided objective comparative measures. Software automation, integration of video and 3D data, appropriate graphical and pictorial depiction of variables and measurements, and further research into the accuracy of FFII as a marker of clinical recovery and assessment of function in facial burns, will enhance future clinical applications and potentially aid surgical reconstruction.

Influence of avosentan (SPP3OI) on the pharmacokinetics of a second generation oral contraceptive containing ethinylestradiol and levonorgestrel in healthy female volunteers.

BACKGROUND: Avosentan (SPP301) is a potent and highly selective ETA receptor blocker and is clinically investigated in diabetic nephropathy. This study was designed to evaluate whether avosentan influences the pharmacokinetics of steroid oral contraceptives. METHODS: During a run-in phase, 16 healthy females received an oral contraceptive containing ethinylestradiol 0.03 mg and levonorgestrel 0.15 mg for the first 21 days of a minimum of one menstrual cycle. In a subsequent double-blind, randomized two menstrual cycle crossover treatment phase, subjects received either avosentan 25 mg or placebo once daily concomitantly with the oral contraceptive. Serum ethinylestradiol and plasma levonorgestrel concentrations were measured on Days 14 and 15 of the two treatment periods for the evaluation of the 24-hour kinetic parameters, and an additional sample was collected on Day 21 to determine their trough concentrations. Serum progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels as well as plasma avosentan and Ro 68-5925 levels were determined on Days 13, 14, 15 and 21 of each cycle of the treatment phase. RESULTS: Avosentan had a statistically significant lowering effect of 9 - 15% on the ethinylestradiol serum concentration levels. The 90% confidence intervals of the pharmacokinetic parameters did not include 1 or exceeded the 0.8 - 1.25 acceptance range for lack of interaction. The plasma concentration-time curves and pharmacokinetic parameters of levonor-gestrel were not statistically different during concomitant treatment with either avosentan or placebo. Compared to placebo, avosentan lowered the serum concentrations of progesterone statistically significantly by about 8% and increased slightly the LH and FSH serum concentrations. Safety and tolerability patterns were comparable during avosentan and placebo administration. CONCLUSION: Because of the effect of avosentan on the concentration levels of ethinylestradiol and progesterone, it is possible that the contraceptive efficacy of low-dose combination oral contraceptives may be adversely affected during avosentan treatment.

Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms.

Assault by acid burns typically results in severe disfigurement, yet the psychosocial impact of this injury is so far unreported. This study provides the first empirical data using standardised assessment scales, from 44 acid burns survivors in Bangladesh. Compared with published norms, individuals show high levels of psychological distress including social anxiety and avoidance, anxiety and depression. Consistent with the published literature, there is no relationship between severity of injury and level of psychological distress. One interesting feature of this population is the relative preservation of perceived self-concept, and this is discussed with relation to the supportive and therapeutic environment of the clinic where this group were studied. We also note an interesting sub-group who were attacked by members of their own family and for whom psychological morbidity seems particularly pronounced.

Facial and ocular injuries associated with methamphetamine production accidents.

PURPOSE: To evaluate the relative contribution of methamphetamine production-related accidents to facial and ocular injuries admitted to a regional burn unit. DESIGN: Retrospective observational case series. METHODS: Chart review of all patients admitted to the Burn Unit at the University of Iowa Hospitals and Clinics (UIHC) over a 16-month interval. RESULTS: Methamphetamine related accidents were responsible for thirteen (9.8%) of 132 patients admitted with facial burns to UIHC during the study period. All victims were male. In addition to facial burns, eight patients (14 eyes) suffered chemical or thermal burns of the ocular surface of Hughes grade I or worse. One patient required full-thickness skins grafts for cicatricial ectropion of all four eyelids. CONCLUSION: In endemic areas such as Iowa, methamphetamine production accidents contribute to as many as 10% of admissions to burn care units for facial and ocular injuries.